The Dreaded Mastitis
One second, you are sitting, snuggling your newborn, trying to google why your left breast feels sore. Out of nowhere, you notice your body starts to change. You feel achy, you have chills, and you are suddenly more exhausted (is that even possible?).
Unfortunately, yes. You have mastitis. Just when you finally start to get the hang of this breastfeeding thing. Try not to worry. This will be yet another challenge during this already chaotic time. However, you have help, and you will get through it.
What is Mastitis?
Mastitis comes from the Greek word “Mastos,” meaning breast or nipple, and “itis” meaning inflammation. Any “itis” or inflammation in the body means that your body is sending all of its healing cells to a certain area to help it recover. Unfortunately, this army of healing warriors can be the reason why you feel so bad. It is what gives you a fever, fatigue, and more swelling in certain areas.
In mastitis your breast may be inflamed for a few reasons but the most common is from milk duct narrowing. A milk duct is the pipe that milk uses to get from where it’s made (milk gland) to the nipple.
What is ductal narrowing?
Think of this as a 4-lane highway suddenly being reduced down to 1 lane. All of the cars (or milk) that are accustomed to flowing freely through that duct, now are backed up for miles and restless to get through. This is very irritating to your breast tissue who then calls for those inflammatory cells to come help. Now starts the cycle of pain and swelling and it can get worse over time.
But what causes these narrow/stopped ducts?
Inadequate milk removal (from things like latching issues, oversupply, hurried feedings, nipple shield use, twins or multiples, blocked nipple pore).
Infrequent or skipped feedings (due to pain, teething, longer sleep cycles for baby, abrupt weaning, mom’s return to work, etc.).
Pressure on the duct (from tight bras or clothing, laying on your stomach to sleep, diaper bags, etc.).
Inflammation (due to injury, infection, or allergy in the area)
Sometimes you may have an infection that comes in through cracked or injured nipples. This can cause a skin infection, which gets inflamed, that will then cause ductal narrowing.
How do I know if I have a clogged duct?
Most women know right away. Usually by the time mastitis presents a woman will already know what it feels like when her breasts are full, the sensation of a letdown, and the feeling of relief after a feed or pump. When you have a clogged duct, you will notice some differences:
A very specific sore spot on your breast.
It feels like a lump that is usually painful when you press on it.
Unlike the rest of the breast, which deflated after the last feed/pump, this spot remained swollen and full.
It may be hard to hold the baby on that side due to pain.
There may be pain with pumping or feeding and a decrease in the milk supply from that side (if you’re pumping and measuring your output).
Some women do not have a lump but just have soreness in that area.
Some women will have redness and/or the area will feel warm to the touch.
Ok, so milk is a little stuck, what is the big deal?
PAIN. Having a clogged duct is uncomfortable and can affect your day-to-day functioning. It makes it hard to feed or pump. It is hard to hold your baby. It is uncomfortable when sleeping. The inflammation may cause fever and chills. You are important and deserve to be pain free ASAP.
Also, if not treated quickly, it can transform into a BACTERIAL INFECTION. Think again about those cars. Birds would never try to land on a moving car, but when those cars are stuck in traffic on the highway, they are now vulnerable to bird landings and bird fecal deposits. Your ducts are similar. When the milk is stuck and cannot get out, it is now a prime location for bacteria to sit and grow, and your milk ducts and glands can get a full-blown bacterial takeover (infection).
While rare, if this infection goes untreated it can spread throughout the body and require hospitalization for IV antibiotics and monitoring.
Ok, you convinced me. A Clogged Duct is an unwanted situation. So, what do I do?
Call your lactation specialist. Professionals trained in how to care for breasts are experts in mastitis. They have seen it before and will help you too. They will ideally help resolve a clogged duct before it gets infected and you do not have to worry about calling the doctor.
Unclog the duct. Your lactation specialist will likely recommend one or all of the following interventions:
-Continue to feed that baby. Frequent breastfeeding or pumping is key to encouraging that clog out. Aim to empty the breast every 2 hours. Do not neglect either breast, especially the normal one. It would be terrible if the other breast became clogged because your focus was on the first troublemaker breast.
-Some women find it helpful to use heat and massage while pumping or feeding. This aims to loosen up the clog with both temperature and mechanical stimulation.
-While uncomfortable, you can use your hand to try to massage the clog from the top of the clog towards the nipple. Almost like you are trying to “milk” it out. This can be done while feeding/pumping, in a warm shower, or even a breast submerged in warm water.
-Ask your lactation specialist about feeding positions. Sometimes certain positions like dangle feeding can use gravity to help relieve the clog.
-Ask your lactation specialist about possible homeopathic remedies. Sometimes they will recommend supplements that will help make the milk less sticky (e.g., sunflower lecithin).
Control the pain. This will help all of the above interventions be more effective since they will not be as limited by pain.
-Ibuprofen (Motrin) regularly. This will reduce inflammation and help with pain. Unless your doctor has explicitly told you NOT to take this medication, it is recommended to take 600-800 mg every 6 hours with food. It is easy to remember if you take it at breakfast, lunch, dinner, and during the first middle of the night feed. You do not need to take it once the clog and pain have resolved. Stop taking it if you get any stomach pain or other concerning symptoms.
-Acetaminophen (Tylenol) regularly. This will help with pain. Unless your doctor has told you NOT to take this medication, it is recommended you take 500-1000mg every 6 hours (the same as the ibuprofen). It is safe to take it at the same time as ibuprofen and I recommend you do so to make it easy to track (breakfast, lunch, dinner, and first middle of the night feed).
-Wear loose clothing. Avoid any tight-fitting bras. Do not sleep on your belly.
More often than not, by implementing these strategies, the clog will resolve and your body will feel better within a few hours. You may still be sore in the area of the prior clog, but as long as it is not a hard lump anymore and you feel better overall, this residual pain will resolve on its own.
Ok, but what if it does not get better?
Sometimes, despite your best efforts, the stubborn clog stays, and bacteria takes over. If you have tried to unclog the duct but your symptoms are the same or worsening, you may have a bacterial infection. The symptoms to look out for include:
a. A clog that has persisted over 12-24 hours
b. Large area of swelling on the breast.
c. The skin over the area will be red.
d. Fever will be present usually with a temperature above 101 F.
e. Whole body symptoms like muscle pain, chills, severe fatigue, and flu-like symptoms are present.
f. Sometimes women will feel a swollen lymph node in their armpit.
If you experience any of these symptoms, now is the time to call the doctor. Antibiotics are warranted to get rid of the bacteria. Now more than ever, unclogging strategies are necessary to help get this clog and infection to resolve. Continue with your lactation specialist’s recommended strategies and take your antibiotics and pain meds (ibuprofen and acetaminophen) as prescribed.
Tell me about these antibiotics. . .
Your doctor will discuss your symptoms and any medical history you may have. They will ask about:
a. Any allergies to medication.
b. Any risk factors for resistant bacteria (MRSA).
c. Any other medications you are taking.
Once you are prescribed medication you will take it for a 10-14-day course. Usually a longer course (14 days) is recommended to prevent inadequate treatment leading to recurring symptoms.
Are these medications safe for my baby?
YES. YES. YES.
The most commonly prescribed antibiotic for infectious mastitis is cefalexin (Keflex). In studies done on breastfeeding moms and their babies. Moms who took cefalexin gave their infant about 0.5% of the dose they received through their breast milk (relative infant dose). For most medications, a relative infant dose of 10% is considered safe, clinically insignificant, and compatible with breastfeeding.
While rare, some infants were noted to have diarrhea when their mothers were taking cefalexin. The importance of treating infectious mastitis significantly outweighs the risk of diarrhea (which will likely not even be noticed by the infant). But feel free to ask your doctor for more information so you feel comfortable with your treatment plan.
You Rock.
Remember, you delivered a baby (or babies!) and are keeping it alive with your own body. You are a ROCK STAR. No matter what happens, you have a village that will help. Reach out early and know that mastitis is another crazy phase and it too shall pass.
